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Clinical Services Coordinator, Intermediate

Blue Shield Of California
San Diego, CA
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External Description Str : Your Role The Children’s Health Program (CHP) ...
Details
Summary
About the job:
team provides identification, referrals, and care management for all Medi-Cal members under 21 years old and collaborates within Promise Clinical Team. The Clinical Services Coordinator Intermediate will report to the CHP Manager. In this role you will work with clinical staff to support member needs using the established and approved Blue Shield Medical Policies and Guidelines which align with nationally recognized standards. You will be responsible for working daily inventory, processing medical records and requests,...
Location:
San Diego, CA
Job Type:
Part-Time
Full-Time
Permanent
Occupation:
Social and Human Service Assistants
Career Level / Education:
High school diploma or equivalent
Salary:
Upper Middle Income Jobs ($50K-$79K)
Certifications / Licenses:
N/A
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
4
apply
Detailed Job Information

Licensed Clinician, Senior- Board Certified Behavior Analyst (BCBA)

Blue Shield Of California
San Diego, CA
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External Description Str : Your Role The Behavioral Health Utilization ...
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Summary
About the job:
Management team performs prospective utilization review for our members and correctly applies the guidelines for nationally recognized levels of care. They collaborate directly with the Member, Member's Family, and Interdisciplinary Care Team to achieve consensus and promote positive Member health outcomes through the assessment, planning, implementation, and evaluation of the Member’s Care Plan. The Licensed Clinician, Senior will report to the Manager, Behavioral Health Utilization Management. In this role you will be...
Location:
San Diego, CA
Job Type:
Full-Time
Permanent
Occupation:
Substance Abuse and Behavioral Disorder Counselors
Career Level / Education:
High school diploma or equivalent
Salary:
Upper Middle Income Jobs ($50K-$79K)
Certifications / Licenses:
Behavior Analyst Certification Board
Workkeys
Applied Math
3
Graphic Literacy
4
Workplace Documents
5
apply
Detailed Job Information

Organization Development and Learning Specialist, Principal

Blue Shield Of California
San Diego, CA
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External Description Str : Your Role The Career and Leadership Development ...
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Summary
About the job:
team provides opportunities for career growth at all levels of the organization through building a culture of learning, galvanizing career ownership and offering leadership development programs that prepare leaders to excel and advance in their careers. As an Organization Development and Learning Specialist, Principal, you will play a key role in strategizing and delivering on all aspects of leadership development across levels. A primary focus of this role will be the design and enterprise-wide launch of the High...
Location:
San Diego, CA
Job Type:
Full-Time
Permanent
Occupation:
Training and Development Specialists
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
N/A
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
5
apply
Detailed Job Information

IT Learning Developer, Senior

Blue Shield Of California
San Diego, CA
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External Description Str : Your Role Join Blue Shield’s dynamic Enterprise ...
Details
Summary
About the job:
Learning organization, which develops learning solutions to ensure employees can perform their jobs effectively to further our mission. As a IT Learning Developer, Senior you will serve as a strategic partner to talent mobility through innovative learning strategies and solutions. The IT Learning Developer, Senior will report to the Senior Manager of Learning Development & Shield Learns. Your Work In this role, you will: - Work with clients to assess learning needs and build learning requirements and learning plans -...
Location:
San Diego, CA
Job Type:
Full-Time
Permanent
Occupation:
Training and Development Specialists
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
N/A
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
5
apply
Detailed Job Information

Social Worker, Senior

Blue Shield Of California
San Diego, CA
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External Description Str : Your Role The Care Management Clinical Social ...
Details
Summary
About the job:
Work team helps Blue Shield members with complex social determinants of health by conducting psychosocial assessments, developing care plans, and providing intensive interventions. The Care Management Social Worker will report to the Manager and/or Senior Manager of Care Management Clinical Social Work. In this role you will be assessing members and linking to appropriate levels of care, linking to community resources, and coordinating with BSC nurses as well as BSC providers. . Your Work In this role, you will: -...
Location:
San Diego, CA
Job Type:
Full-Time
Permanent
Occupation:
Mental Health and Substance Abuse Social Workers
Career Level / Education:
Bachelor's degree
Salary:
High Income Jobs ($80K-$99K)
Certifications / Licenses:
Licensed marriage and family therapist
Licensed Clinical Social Worker
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
4
apply
Detailed Job Information

Case Management - Nurse, Consultant

Blue Shield Of California
San Diego, CA
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External Description Str : Your Role The Care Management team will serve to ...
Details
Summary
About the job:
support the mission of the department, which is to provide support to patients in maintaining health and wellness in the outpatient setting. The Nurse Consultant will report to the Manager of Care Management for the Population Health Management Medi-Cal Team. In this role, you will ensure that services are provided based on standardized procedures including coordination of care with specialists and community resources. Care Managers perform a blended function of utilization management (UM) and care management (CM)...
Location:
San Diego, CA
Job Type:
Full-Time
Permanent
Occupation:
Registered Nurses
Career Level / Education:
Associate's degree
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
Certified Registered Nurse
Certified Case Manager
Workkeys
Applied Math
5
Graphic Literacy
4
Workplace Documents
5
apply
Detailed Job Information

Case Management - Nurse, Senior

Blue Shield Of California
San Diego, CA
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External Description Str : Your Role The Federal Employee Program (FEP) team ...
Details
Summary
About the job:
performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members’ care including clinical nurses and treating physicians . The Registered Nurse Case Manager will report to the FEP Department Manager. In this role you will determine, develop, and implement a plan of care based on accurate and comprehensive assessment of the member’s needs. Your Work In this role, you will: - Research and...
Location:
San Diego, CA
Job Type:
Part-Time
Full-Time
Permanent
Occupation:
Registered Nurses
Career Level / Education:
Associate's degree
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
Certified Case Manager
Certified Registered Nurse
National Committee for Quality Assurance
Workkeys
Applied Math
5
Graphic Literacy
4
Workplace Documents
5
apply
Detailed Job Information

Case Management - Nurse, Senior (CA Children's Health)

Blue Shield Of California
San Diego, CA
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External Description Str : Your Role The Children’s Health Program (CHP) ...
Details
Summary
About the job:
team provides identification, referrals, and care management for all Medi-Cal members under 21 years old and collaborates within Promise Clinical Team. The Case Management, Senior will report to the CHP Manager. In this role you will be Perform clinical review, assessment, evaluation of medical services for the organization using the established and approved Blue Shield Medical Policies and CCS/EIES/DDS/ECM Eligibility guideline which align with nationally recognized standards. Responsible for managing member needs for...
Location:
San Diego, CA
Job Type:
Full-Time
Permanent
Occupation:
Registered Nurses
Career Level / Education:
Associate's degree
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
Certified HIPAA Professional
National Committee for Quality Assurance
Certified Registered Nurse
Certified Coding Specialist
Workkeys
Applied Math
5
Graphic Literacy
4
Workplace Documents
5
apply
Detailed Job Information

Utilization Management Nurse, Consultant

Blue Shield Of California
San Diego, CA
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External Description Str : Your Role The Utilization Management team ...
Details
Summary
About the job:
facilitates the review of requests for medical necessity to assure that care is provided to our members timely, at the correct level of care with quality and cost effectiveness standards. The Utilization Management Nurse Consultant will report to the Utilization Management Manager. In this role you will be an individual with advanced level knowledge. Considered the subject matter expert (SME) and could engage in project or program management activities. Your Work In this role, you will: - Perform prospective, concurrent and...
Location:
San Diego, CA
Job Type:
Full-Time
Permanent
Occupation:
Medical and Health Services Managers
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
Certified Registered Nurse
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
5
apply
Detailed Job Information

Program Manager Clinical, Principal

Blue Shield Of California
San Diego, CA
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External Description Str : Your Role The Care Management Department, which ...
Details
Summary
About the job:
oversees all outpatient care management for the Commercial and Medicare lines of business, is seeking a Clinical Program Manager, Principal to join our team. In this role, the candidate will provide comprehensive support and collaborate effectively with stakeholders across various departments. The ideal candidate must possess extensive care management experience and be a subject matter expert in compliance and regulatory requirements, particularly with a strong understanding of NCQA (National Committee for Quality...
Location:
San Diego, CA
Job Type:
Full-Time
Permanent
Occupation:
Medical and Health Services Managers
Career Level / Education:
Bachelor's degree
Salary:
Six Figure Jobs (more than $100K)
Certifications / Licenses:
Certified Registered Nurse
National Committee for Quality Assurance
Workkeys
Applied Math
4
Graphic Literacy
4
Workplace Documents
5
apply
Detailed Job Information
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Location: San Diego
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Industry: Health Care and Social Assistance
Company Name: Blue Shield Of California
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